Good Medicine: A story of kindness starting with lentils

“I don’t know beans about your question," I said jokingly to my patient Vince, who smiled politely at my attempt at a humorous quip.

Vince had G6PD deficiency, which he had learned about from required blood screening as an Army officer. He was interested in improving his performance as a long-distance runner and had learned that many long-distance athletes are choosing plant-based diets to fuel their performance. He wondered if the highly nutritious, protein-packed lentil bean would be OK for him with his G6PD deficiency. I could tell by Vince’s last name that he and I shared Italian heritage. I told Vince that joking aside, I actually had more experience with lentils than any other beans.

I explained that My Uncle Vito, a barber, always had a pot of lentil soup simmering on the stove whenever my brothers and I showed up at his house for a haircut. As a youth my initial inclination was to pass on the lentil soup as it did not have quite the curb appeal of alphabet soup. However when your UNCLE VITO makes you an offer of lentil soup, it really is an offer you can’t refuse! With a nod and a smile Vince understood my acquiescence. In time however, lentils became a favorite of mine and to this day I relish a bowl of lentil soup, and with some friends just recently savored a hearty bowl with a Greek flair at Chris’s Kitchen in Chambersburg.

Lentils originated in the Middle East and Mediterranean and have influenced the course of history. Esau gave up his birthright for a bowl of crimson lentils. Shammah was designated a Mighty Warrior of David for defending a field of lentils from a Philistine attack. Perhaps in Divine calculus a “hill of beans” is worth more than we ever imagined. Lentils have been a staple food in the Mediterranean for as long as can be remembered.

G6PD deficiency, for which Vince tested positive, is an x-linked recessive genetic disorder occurring more commonly in males and most often affecting people of African, Mediterranean, Middle Eastern or Asian ancestry with a prevalence of 1-5% in those populations. G6PD affects red blood cells (RBCs), which are the vital oxygen-carrying cells in our blood.

RBCs are rather stunning in their design and composition and once mature in the bloodstream, they function for an average of 120 days before breaking down. As RBCs break down and are then metabolized by the body there is a well-choreographed dance between the blood, bone marrow and kidneys to replenish the natural attrition. G6PD deficiency predisposes the RBC to be a little more structurally fragile and break down more rapidly, a condition called hemolysis, when exposed to certain triggers. Among the triggers are certain medications including some to treat malaria; foods especially fava beans, but all beans and legumes and even blueberries could be triggers; and finally certain infections can be severe triggers. When rapid hemolysis occurs the body can’t keep up with the demand for red cells and the patient becomes anemic.

Given Vince’s Italian background I asked him if he too had eaten lentils as a child. He said that he had eaten lentils and plenty of other beans and and peanuts without a problem until he joined the Army and found out he was G6PD deficient. I then asked family history and specifically whether any family members had experienced hemolytic anemia, anemia of any kind, or any blood problems. Here the story got really interesting.

Vince told me his grandfather, his mother’s father, had been from the hills around Salerno, had been an Italian special forces soldier “Bersaglieri” in WWII and was captured in North Africa by American Forces. He was sent to America on a Liberty ship to a POW camp just down the road at Letterkenny Army Depot.

Vince said his grandfather spoke of how the American soldiers who captured him did not treat him like an enemy but with dignity and kindness. His grandfather extolled the generosity and many kindnesses shown to him and his countrymen by the people of Chambersburg and the soldiers and civilians at Letterkenny Army Depot. Having experienced the graciousness and goodwill of many Americans, after the war his grandfather returned to Italy for his wife and children and they immigrated to Pittsburgh. “I don’t know for sure about any relatives with blood illnesses, but my mom said that family lore suggests we should avoid fava beans,” Vince said. Fava beans have been known since ancient times to trigger illness in some people called “Favism,” which is the hemolytic anemia manifestation of G6PD

As Vince told the story of his family I realized that the real reason he was here before me today was because of kindness. Kindness to strangers and love of enemies has been a Biblical imperative from the Book of Deuteronomy to the Book of Luke. How exceedingly rare and almost irrational it seems to show true kindness to an enemy in real life. Yet such unnatural kindness could be transformative for all involved. I have often wondered if kindness can radiate like a wave of light and like light waves, be detected generations later. Certainly this highly accomplished young American Army officer before me today was here because of kindness to an enemy, his grandfather, two generations before.

This extraordinary kindness of the people of Chambersburg and the Letterkenny staff to the 1,250 Italian POWs at Letterkenny during WWII has in fact been celebrated on two continents and written about in a recent book, “World War II Italian Prisoners of War in Chambersburg.” That kindness has certainly reverberated for several generations.

From the medical perspective kindness has been shown to be healthy for both the receiver of kindness and the giver of kindness. Research by Dr. Stephen Post at Case Western Reserve School of Medicine has demonstrated that acts of kindness improve the immune system, elevate brain neuro-hormones like dopamine, which create “the helper’s high,” and improve mood. Acts of kindness also reduce stress hormones such as cortisol, decrease inflammatory markers, and some evidence suggests they may increase longevity. Further research at Yale shows that small acts of kindness may be just as beneficial as more heroic acts of kindness.

But, Vince didn’t make an appointment just to chat about family history, he needed some thoughtful medical advice to help him achieve his fitness and competitive running goals. I told Vince that G6PD is quite variable in how it affects people and the fact that he had eaten lentils before without a problem means that there is a high likelihood that lentils are not a trigger for him. However, lentils are on the list of possible trigger foods so I could not give him a guarantee that they would never cause him a problem. Detailed genetic testing is available to identify the more severe subtypes of G6PD deficiency. In addition, Pennsylvania is one of a few states that test newborns routinely for G6PD, so if any of his children were born in Pa. they would have been tested.

However, in the interest of goodwill, good running and and to avoid getting inadvertently “beaned," I would make him an offer he should not refuse! That offer was to see one of my trusted colleagues, also an Army officer, a registered dietitian/nutritionist who had just run the Boston Marathon and who had participated in the Plant-Based healthy Eating Adventure in Franklin County. She could expertly help him with all his nutritional needs, lentils or no lentils, with good plant-based fuel for great performance.

“Cool beans,” Vince quipped back with a laugh. I laughed as well and as we shook hands to end our time together I thought to myself, “There is much about which I don’t know beans, but make no beans about this: Kindness is always ‘Good Medicine,' and in peace and especially in war, often long remembered.”

Finally, for more information about the Italian POWs and the beautiful Letterkenny Chapel, contact: Historic Letterkenny Chapel and Franklin County Veterans and 9/11 Memorial Park, www.VeteranTrailPA.org.

For more information about G6PD contact the G6PD Association.

If you want to know beans…

Dr. Mike Gaudiose was a Family Physician in Chambersburg for 35+ years and now serves at Dunham Army Health Clinic at the Army War College in Carlisle. He occasionally shares stories of “doctoring” in Franklin County. Names and places may be altered a bit to maintain confidentiality.